A Physician Asks: Is Being Black Bad For Your Health?
TERRY GROSS, HOST:
This is FRESH AIR. I'm Terry Gross. Is being black bad for your health? It seemed that way when Damon Tweedy was in med school and most of the diseases he was learning about came with the warning that they were more prevalent among black people and that the outcome was worse for black patients than white ones. Dr. Tweedy is black and was himself enough diagnosed with chronic health conditions in his 20s. He's written a new memoir called "Black Man In A White Coat: A Doctor's Reflections On Race And Medicine." He's a graduate of Duke Medical School and Yale Law School and is an assistant professor of psychiatry at Duke University Medical Center and a staff physician at the Durham VA Medical Center. He was raised by working-class parents. His father was raised in rural poverty, didn't finish high school and worked for 35 years as a meat cutter in a grocery. Tweedy's mother went to segregated inner-city schools and couldn't afford college. Tweedy was given a full scholarship at Duke, and one of the issues he examines in his book is affirmative action. Dr. Damon Tweedy, welcome to FRESH AIR. So when you were in medical school and every time one of your teachers was talking about a disease and you'd be told it's more common among black people, what did you initially make of that?
DAMON TWEEDY: There was a part of me that really wanted to find out the answer. I mean, so there was this one part that thought, well, is this just all genetic? Is this based on class? You know, is this an economic thing? You know, what is it all about? And I was just dissatisfied to almost feel as if I was not getting an answer. So that was really part of the struggle that I dealt with.
GROSS: And do you feel like you have an answer now?
TWEEDY: I think I do. I think I have a much better answer than I did then. It's almost best to think about it - there are several examples that I saw along the way that really sort of - really underscore, you know, what's really going on. One time, early in medical school - this is probably my third year - basically, we volunteered at a rural charity clinic. It was about 90 minutes from campus, and the patients there were all African-American. They didn't have health insurance. And it was pretty clear from the beginning that you're just delivering a lower standard of care in the sense that - I mean, the doctors were doing the best they could, but the patients often couldn't afford the medications and the lab tests and all the other treatments that they needed. So that really was a - you know, a real stark example of how black people in this particular case really can face worse health problems in a really obvious way.
GROSS: And another?
TWEEDY: So I think - so there's issues at the system level. Then there's another layer when you're talking about the doctor and the patient and how they interact - and so issues around trust and communication. So those are really important in the sense that the patient has - the doctor and patient are partnering together, you know, to improve their health. So there's been a lot of things that happened in the past that have really still impacted the present. There's been a long history of African-Americans being, you know, mistreated by the health care system. And even though it seems like a long time ago, you know, for instance, the Tuskegee study ended in 1972. You know, that's over 40 years ago, but a lot of people are still living from then that were around back then. And I think there is - for many people, there is a - there's sort of this residual mistrust that often can manifest itself. I'll see patients now have diabetes and high blood pressure, and they're wondering, you know, are they getting the right treatment? They're feeling like maybe they're getting some kind of lower level of care when, in fact, oftentimes they're not. So it's a real - that's another real important issue that's at work.
GROSS: So let's get to a kind of complicated case that you had to deal with when you were a new, young medical student at Duke. You were seeing a patient who had just come in, a teenage girl who appeared to be several months pregnant and was having terrible abdominal pain, vaginal bleeding. You figured she was pregnant, but she denied being pregnant. And how did you try to find out what the problem was?
TWEEDY: Yeah, so my first thought was that maybe there was a psychiatric illness like schizophrenia or something along those lines. I had just gotten off of a psychiatry rotation seeing people who dealt with similar issues. Actually, what you often saw there were women who thought they were pregnant and they actually weren't, so it was sort of the opposite situation. But in talking to her, and it was pretty clear, at least from my standpoint, that she - it wasn't that kind of an illness she was dealing with. So then my next thought was well, what else could sort of alter your mental state in that way? And my next thought was drug use. So I asked her about that. And, you know, she flat out denied it. And I said well, I don't know. She said no, where else is there to go? And the supervisor came in - and this happens to medical students all the time - so the supervisor came in, asked the same line of questioning, only she was very direct and sort of, like, accusatory. When is the last time, you know, you smoked crack? That's the words she put in there.
So I was shocked just at the way she approached the patient in that way. I'm thinking well, why does she think that about the patient? So - and I was - my first thoughts were maybe it's because the patient's poor. She's still kind of not that well put together maybe because she's a young black girl. All these sorts of things were running through my mind. And then I was equally shocked when the patient - when the young girl then turned around and said yes, I smoked crack a couple of days ago. Well, I'm like well, why did she lie to me? I mean, what was I going to do? Why did she lie to me? So it was a situation that many medical students find themselves in, where they're - kind of don't know how to ask people about these really serious and sensitive issues.
GROSS: Do you think that your supervisor did the right thing in bluntly and in an accusatory way saying when was the last time you did crack? It got a real answer, but it sounds very - like you said, very accusatory.
TWEEDY: Yeah, I'm sure there's - I mean, yes, she got the right answer. Unfortunately, in this case, it didn't change the outcome. You know, unfortunately, in this case, the young woman - her pregnancy ended up being a still birth. So the fetus was about 20 - you know, 20 weeks, and it was a still birth. So it didn't change the outcome. But in some cases, that could be a really important piece of information to obtain that could perhaps change things. And so yeah, I would say that there probably could've been an easier way to have done it, maybe a less direct way. But, you know, she was busy, and it just needed to be done. It's like a life and death kind of situation for her. So I understand - looking back, I kind of understand it. I was actually more troubled by one of the other staff members who, after the stillbirth, you know, after it was clear that the baby wasn't going to survive, this other staff member basically was talking about sterilizing the young girl right then and there. So that was actually more troubling to me than the supervisor's approach because it just seemed like wow, we're just going from this to automatically sterilizing her permanently. And that just seemed a pretty harsh and drastic thing to do in that situation.
GROSS: And the doctor did not think that that was an appropriate thing to do or even an appropriate conversation to have with the patient.
TWEEDY: Right. So even though she initially came with this sort of really blunt, accusatory style, she actually defended the patient against that. She said this is definitely not the place for this. This girl just had this traumatic experience. She has plenty of time to get her life together. Why are we - we're not going to do this right now. And so I respected that. So I mean - so I think that, you know, despite that initial sort of - I was, you know, put off a little bit in the beginning, I think I actually was very respectful of how she handled the situation.
GROSS: You had an interesting experience as a patient. When you had a sprained knee, you went to see a doctor. The doctor was white. What happened that made you feel like you weren't being treated well?
TWEEDY: Yeah, so I had a knee that was sore. I had been playing tennis and tweaked it in some way. And I went to an urgent-care clinic after about a week or so of the swelling not going down. I tried to doctor myself, like most of us doctors do. When that didn't work, you know, I went to this clinic. So the doctor walks in the room, and first of all, he doesn't make eye contact, doesn't really talk to me, just looks at my leg and has me stand up and down a couple of times. And then just says oh, you're OK, you know, you're fine. But I knew that, being a doctor, there were a lot of pieces missing. So for instance, the doctor didn't know what kind of work I did and whether or not I needed to move around. And there were just a lot of gaps there. He didn't actually touch the knee or examine the knee. And so I knew that there were several things that you should probably do in this situation.
And so I made the point to the doctor, well, you know, I know something - a little bit about medicine. You know, normally, I don't do that when I'm the patient. But in this case, I felt like I had to. And the doctor was taken aback. And suddenly, it was like a light went off in his head. And suddenly, he looked at me. He made eye contact. He started to engage me in a conversation. Then he started - he examined my knee, touched my knee, moved it back and forth. And - oh, let's go get an x-ray. Let's make sure everything's OK. So it was really - that was really like I was two different people at the same time. The first person was, you know, Damon Tweedy coming off the street. And so that particular day, I had come from home, and I was dressed in sweat clothes and a T-shirt. So I was very casually dressed. He may have had certain assumptions that were negative about me. But then once he learned I was a doctor, it was like I'm suddenly this other person, and I'm worthy of a whole different level of care. So I think it really illustrates the different ways in which these things can interject in the exam room.
GROSS: So you think it's very important to have more black doctors. Why do you think it's so important?
TWEEDY: Well, first of all, if you think about the numbers - so the general African-American population is about 13 percent of the country. Among doctors, it's about 4 percent. So it's a little higher among medical students who are training now, but it's been - overall among doctors, it's about 4 percent. And, you know, there's this real legacy of the health care system and doctors not being kind to African-Americans that still persists. Sometimes, I feel like a translator in some ways. I can relate to the environment to a great extent to where they're coming from, and I'm also sort of a bridge between that and this sort of alien medical world. So I think many black doctors are - find themselves in that same situation. So - and I also - you'll find that many young black doctors are more likely to express a desire to being in a setting or career where they're actually helping the black community itself. So I think that's - those are the reasons why it's really important.
GROSS: When you were in medical school, you say you felt at a disadvantage academically and socially because you were from a working-class background. A lot of the people at Duke were the sons and daughters of, like, doctors and lawyers. Your father had been a meat cutter who didn't graduate high school. Your mother couldn't afford to go to college so going to college was a really big deal in your family. And then to make it even worse, to make it even more difficult for you 'cause here you are feeling like an outsider in medical school, one of your teachers, when he saw you walk into the classroom, asked if you were there to fix the lights. So that couldn't have given you a lot of confidence (laughter).
TWEEDY: No (laughter). Yeah, so - yeah, this was, like, about a month into my first year of medical school. And it was a break between classes, and I walked into the classroom and - this was a really bad case of mistaken identity. So the professor comes up to me somewhat angrily and says, you know, are you here to fix the lights, and, you know, why haven't you done this? I already called you about this last week. So he thought I was someone that I wasn't. So, you know, my first reaction actually was to look at myself and wonder if I had done something wrong. Like, did I not shave? Did I not dress right? What had I done wrong? Once I realized that that wasn't the case, I'm looking outward and thinking well, why does he think this about me? And so race was obviously one of the first things that did come to mind. And certainly there are - he's probably more likely to have seen black men in that capacity at Duke. And so I - I mean, but it something that was still was very - I struggle with it a lot, you know, how to deal with that hurtful thing. So the issue was then what do I do with that? How do I deal with that situation? And so what I did is - you know, I was concerned that if I went and talked to other professors, they might not understand why I was seeing it that way. They may think that I was just trying to make a racial issue out of everything. And so I just - I was really reluctant to do that. So the way that I dealt with it was to just put everything I had into studying around the clock and showing this guy that, you know, I belong there just like anyone else.
GROSS: And you did so well that he asked you later to become his assistant, and you declined.
TWEEDY: Yeah. I mean, so at the very end of the semester, I ended up getting, like, the second-highest grade on the exam. And I went to meet with him to see if I'd, you know, gotten the honors credit, which is for, like, the top five or 10 students in the course. And yeah, it was this awkward exchange because he it seemed like he recognized me from before, but he didn't want to acknowledge that. And then when he did see me, you know, when he saw the score, he sort of had this look of surprise. And it was suddenly like - you know, it was a switch. It was like the expectations were so low for a black person, if he did this well, then you really must be special. You know, can you work with me? And so it was like a mixed feeling. You know, there's a part of me that, you know, obviously, you're happy that you've succeed and proved yourself. But then there's sort of this, like, mixed legacy of the whole thing as well.
GROSS: If you're just joining us, my guest is Dr. Damon Tweedy. He's the author of the new memoir "Black Man In A White Coat: A Doctor's Reflections On Race And Medicine." Let's take a short break, then we'll talk some more. This is FRESH AIR.
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GROSS: This is FRESH AIR. And if you're just joining us, my guest is Dr. Damon Tweedy, author of the new memoir "Black Man in a White Coat, A Doctor's Reflections on Race and Medicine." He started medical school in 1996 and is now an assistant professor of psychiatry at Duke University Medical Center and a staff physician at the Durham VA Medical Center. You know, we've talked a little bit about - for a lot of patients who are African-American, it's important to them to see an African-American doctor, that a lot of black people are distrustful of the medical system because of just unethical experiments that had been done on black people over the years and because they sometimes feel they get substandard care. And sometimes they do. On the other hand, there are patients who don't want a black doctor. And you write about that, too. Even some black patients - like you write about a black patient, you walk into the room and I'm going to quote what you write here. That....
GROSS: That the patient says, (reading) oh, they're passing you off on me. And they think I won't care because I'm supposed to be a dumb N-word. So go tell your boss I don't want no black doctor.
How did you respond to that?
TWEEDY: Yeah that hit me like an uppercut, basically. So there - you know, there's certainly a legacy. It goes back to the times of segregation and even probably further back than that, where it's often thought that whatever was black was inferior, right? So you often would hear people say that a black doctor was inferior to, say, a Jewish doctor or a black businessperson was inferior to, you know, a white businessperson. So there was certainly that legacy that certainly existed because of, you know, the history and what we had during the era of segregation. And so that was sort of a reminder that that mindset still was still out there, that I had to deal with that. So yes, it was certainly like an uppercut. And I stumbled at first, but then I realized that this was an opportunity for me to - again to show what I was made of. And that patient - I just made a commitment to really show him how much I knew and how confident I was. And, you know, at the end of that time he was in the hospital, he actually ended up giving me a very good comment. I got to know him as a person and we talked more. And he told me that, you know, he really thought that I was a good doctor. And he actually said I'm the kind of doctor that he would want. So I really turned that really negative situation into a positive one. But yeah, it still - there's this lingering sort of feeling that shows that there's still this legacy of troubling feelings about one – about our self that we have to deal with.
GROSS: When you were in college, the first time you dissected a rat, you fainted. Did you think that that would make it impossible for you to be a medical student or a doctor?
TWEEDY: Yeah, that was not the best first impression. So this - actually the very first day of my - I was in a research lab - the very, very first day, and I walk into the room, meet the guy I'm going to work with, the supervisor for the summer. And then he takes me to this room where there are - where there's like a lab tech person who's operating on these rats. And I'm talking to her, and then suddenly, it's like there's blue spots in my vision. And then the next thing I recall is her just saying watch your head, don't let him fall. And then there are a bunch of - and the next thing I know, I'm on a stretcher and there are a bunch doctors talking in doctor-speak and sending me to the emergency room. So that was like about the worst first impression you can ever imagine on a job.
So yeah, I think I had some doubts at that point, and I think they did, too. So they brought me along a little slowly after that. I'm sure they were wary of things. But, you know, it was, again, one of those things where you have to - you know, can I do this or can I not? And what am I made of? And so I really just was determined that I wasn't going to let that first impression be the last of it for them. So I actually spent the whole summer there and then came back the following year and they gave me great recommendations for medical school. But yeah, not a good first impression.
GROSS: Did it seem funny to you that here you are, like, you're 6'6'', you're incredibly athletic, but, you know, but you're fainting because you're dissecting a rat.
TWEEDY: Yeah exactly.
GROSS: Right, so did you - were you able to, like, get over that and I'm also wondering if not feeling comfortable around, like, dissections or maybe open wounds or, you know, blood led to your interest in psychiatry as opposed to surgery?
TWEEDY: When I was in medical school, you know, I got - I actually got over that. And I was - I did well on my surgery rotation. And I was really all set to become a cardiologist. I was really interested in the heart. You know, I - diagnosed with high blood pressure myself. My mama - my grandmother had died from heart failure. I was really interested in the heart. I had done some research in that area in college and in medical school. So I thought that that's where actually I was going to head up, so I really had overcome that. And psychiatry was actually low on my list of things when I was a medical student. I actually didn't enjoy my initial rotation through the field that much. I think the switch happened during that internship year - that very first year as a young doctor. And, you know, I found myself really gravitating toward - you'd have patients admitted to your team who had psychiatric illness, but they also had a medical problem. And that's why they had to be in the hospital. And I just found myself being really interested in their stories and learning about them and why they were doing what they did and the struggles they had. Towards the end, you know, I got more enjoyment out of learning about people than I did so, like, managing heart failure or pneumonia. And so that's really what kind of led me towards this path toward psychiatry. So it certainly was circuitous.
GROSS: Were you exposed to psychiatry at all when you were growing up, or was that just a - kind of like, outside the realm?
TWEEDY: So you certainly would see people on television, but the interesting thing about psychiatry - and this is a whole another layer to it, there was - sort of bring it back to the subject of race and medicine. As if psychiatry is like - growing up it was like that's something for other, you know, for white people primarily - that black people don't go to a psychiatrist or a therapist and talk about their problems. You deal with them yourself, or you talk, you know, within family or within your church. And so I think there's certainly a whole layer that's there for that. So the idea of me being in psychiatry was really - my mom was incredibly surprised. She's like, what? What are you doing? You know, and so that is definitely not something that I grew up with at all.
GROSS: Have you met patients for whom seeing a psychiatrist or admitting to having some kind of psychiatric issue is a sign of weakness? Something that you're not supposed to display?
TWEEDY: That's a huge problem. It tends to be more common in men, for sure. I mean, you know, there's the sort of the macho stance that....
TWEEDY: Yeah, exactly. It's certainly that. But I think it's even – again, more common in African-American people. There's this perception that that's just not something that you do or you need to do and that, you know, those are largely, you know, white problems. And so, you know, you can't afford to have problems like that. You have all these other real-world things to deal with, right? And you have to deal with, you know, getting by in life and not worrying about, you know, some of these other sort of things. So that's a huge issue. And that's a barrier that I encounter a lot. And I try and just make it normalized. I think people have all sorts of ideas when they come to see a psychiatrist. They think that - first they think you're going to tell them that they're crazy and that you're going to lock them up in a hospital. People are just really worried about those sorts of things. I try and just make it, you know – as normalize it as possible. And just say that, you know, everybody has stress. I use the word, like, stress because, you know, that's something people can relate to. And I try and use that as an entry to sort of get people talking about what's going on.
GROSS: Damon Tweedy, thank you so much for talking with us.
TWEEDY: Thank you.
GROSS: Dr. Damon Tweedy is the author of the new memoir "Black Man in a White Coat: A Doctor's reflections on Race and Medicine." After we take a short break, we'll hear from Alison Brie, the co-star of "Mad Men" and "Community." She stars in the new film "Sleeping with Other People." And we'll find out what our TV critic David Bianculli thought of last night's season premiere of "The Late Show With Stephen Colbert.” I'm Terry Gross and this is FRESH AIR.
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